This application responds to two program announcements: 1) "Drug Abuse Health Services Research" (PA-94-047) and "Drug and Alcohol Use in Rural America" (PA-95-060). In this 5-year project, Wright State University proposes to conduct health services research among rural crack users in four nonmetropolitan counties in west-central Ohio. Focusing on crack-cocaine abuse, this research will provide the field with descriptive and analytic data relating aspects of rural life with the phenomena of drug abuse and health service use. The overall goal of this proposal is to recruit 225 active crack users and interview them every six months over a three-year period. A natural history design will be used to examine rural crack user's substance abuse practices, health care needs, barriers to obtaining care, and service utilization patterns over time. Participants will be recruited using a modified version of chain-referral sampling, called Respondent-Driven Sampling. The Specific Aims are to: 1. Identify and describe key dimensions of rural crack abuse and health service utilization using ethnographic methods. 2. Describe the characteristics of 225 active crack-cocaine users recruited from four rural counties in west-central Ohio. 3. Identify the factors that predict changes in crack and other substance abuse among rural crack abusers over a three-year period. 4. Describe the barriers to obtaining substance abuse treatment among rural crack abusers and identify the correlates of the barriers. 5. Identify the factors that predict rural crack smoker's use of drug abuse treatment services over a three-year period. 6. Identify the factors that predict rural crack smoker's use of general and mental health services over a three-year period. 7. Describe and analyze the similarities and differences between the new sample of 225 rural crack users and our established sample of 430 urban crack smokers using cross-sectional and longitudinal data. The scientific value of the proposed research is found in its potential to broaden and deepen our understanding of drug abusers and health seeking behaviors in rural areas. Finally, the data provided by this study will help policy makers plan prevention activities and develop a treatment response for drug abusers in rural areas.